Roadmapping the brain to improve surgery

What: With Society funding, researchers are developing technology that can improve surgery by providing a more detailed image of the brain.

Why: Surgeons can use the detailed images to develop a plan that removes as much of the tumour as possible while preventing damage to the brain.

Researchers across different disciplines are working together to use technology to create detailed roadmaps of the brain, a development that will help to improve brain cancer surgery.

With Canadian Cancer Society funding, Dr Simon Graham, a medical physicist at Sunnybrook Hospital, and Dr Sunit Das, a neurosurgeon at St. Michael’s Hospital, are working to improve MRI technology used during brain surgery.

Many patients with brain cancer need surgery to remove the tumours. Surgeons rely on MRI images of the brain to plan the surgeries. Currently, MRI technology shows the structure of the brain and where the tumour is located, but is limited when it comes to showing brain activity.

Dr Graham and Dr Das are testing the use of functional MRI (fMRI), which provides an extra layer of detail that shows which regions of the brain are active when a patient performs a particular task, such as counting or spelling.

“Functional MRI has been used for neuroscience research, but using this technology in the clinic is quite new,” says Dr Graham. “I want to do work that has clinical applications in medicine.”

Dr Graham and his team developed a new tablet-based technology, where patients perform tasks while in an MRI machine to provide detailed information about brain activity. Dr Das is then using the information gained through the fMRI and tablet technology to plan a roadmap for surgery of how to get to and remove as much of the tumour as possible while causing the least amount of brain injury to the patient.

“This technology allows me to be remarkably aggressive in patients with these tumours,” says Dr Das. “It seems counterintuitive, but once I know what part of the brain needs to be protected, I can be remarkably aggressive with the rest.”

Dr Graham and Dr Das – along with a multi-disciplinary team that includes neuroscientists, anesthesiologists and a speech pathologist – have already used this technology to plan surgeries for close to 30 patients. While they are currently focused on improving the technology for surgery, in the future they hope to study whether it also improves survival and side effects for patients.

The support of the Canadian Cancer Society was essential to moving the research forward to the point where it can be used in patients.

“I had the desire to have a tool like this for my patients at the same time that Dr Graham had pushed this remarkable technology forward to a place where it was ready to be translated into the clinic,” says Dr Das. “The support of the Canadian Cancer Society and our team has let us do highly innovative work to help patients.”